Incidence, Risk Factors, and Clinical Sequelae of Angiographic Peri-Stent Contrast Staining After Sirolimus-Eluting Stent Implantation

Abstract

Background-We have noted abnormal angiographic findings-at the sites of drug-eluting stent implantation, suggesting contrast staining outside the stent struts-that do not fulfill the classic definition of coronary artery aneurysm. We propose a new term, peri-stent contrast staining (PSS), for these abnormal angiographic findings and assess their incidence, risk factors, and clinical sequelae. Methods and Results-Peri-stent contrast staining was defined as contrast staining outside the stent contour extending to Ն20% of the stent diameter. The study population consisted of 3081 lesions (1998 patients) that were treated exclusively with sirolimus-eluting stents and were evaluated by follow-up angiography within 12 months after sirolimus-eluting stent implantation in a single center. Late acquired PSS was observed in 58 lesions (1.9%) in 49 patients (2.5%). Independent risk factors of PSS included chronic total occlusion, whereas negative risk factors for PSS were left circumflex coronary artery lesion and in-stent restenosis lesion. Stent fracture was more frequently observed in lesions with PSS than in lesions without PSS (43.1% versus 5.4%, PϽ0.0001). Excluding 269 lesions with target-lesion revascularization within 12 months, the study population for long-term follow-up consisted of 51 lesions (42 patients) with PSS and 2761 lesions (1751 patients) without PSS. Cumulative incidence of target-lesion revascularization and definite very late stent thrombosis at 3 years in the PSS group was higher than that in the non-PSS group (15.0% versus 6.5%, and 8.2% versus 0.2%, respectively). Conclusions-Peri-stent contrast staining found within 12 months after sirolimus-eluting stent implantation appeared to be associated with subsequent target-lesion revascularization and very late stent thrombosis. (Circulation. 2011;123:2382-2391.)

Angioscopic Assessment of Peri-Stent Contrast Staining Following Drug-Eluting Stent Implantation

“…Imai et al reported that CTO is a risk factor for PSS formation. 5 In our study, 64% of the DESs were implanted in CTO lesions. As CTO is organized from a thrombotic lesion, 18 we can infer that there is a mechanism for thrombus underneath the stent to be dissolved.…”

Optical coherence tomography in primary percutaneous coronary intervention: Helping to clear the angiographic fog

“…This finding was defined as contrast extending peri-stent to > 20% of the stent diameter. These authors also observed that PSS in patients with sirolimus-eluting stent (SES) implantation was associated with higher rates of VLST at 3-year follow-up (compared with patients without PSS) [8] .…”

“…Published articles describe various treatment options: stent implantation (DES as well as bare-metal stents); balloon angioplasty; or conservative treatment [9] . Even if we do not have solid scientific evidence for it, life-long dual antiplatelet therapy is a reasonable therapeutic option for these patients [8] . In our case, OCT was the tool that helped us to decide on an optimal treatment strategy (intrastent 5 mm balloon angioplasty) and to evaluate the final intracoronary result.…”

Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation ― 5-Year Outcomes ―

“…14 Peri-stent contrast staining (PSS) is contrast staining outside stent struts after stent implanta-ments or stent struts confirmed by follow-up angiography and was evaluated in multiple views. 16 PSS was defined as contrast staining outside the stent contour extending over 20% of the stent diameter measured by QCA and was classified into 4 patterns according to our previous report. 16 a diagnosis of PSS and SF at follow-up angiography at 8 months.…”

“…16 PSS was defined as contrast staining outside the stent contour extending over 20% of the stent diameter measured by QCA and was classified into 4 patterns according to our previous report. 16 a diagnosis of PSS and SF at follow-up angiography at 8 months. Informed consent was given by all patients for both the procedure and subsequent data collection and analysis for research purposes, and the study was approved by the institutional ethics committee.…”